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Effect on hospital attendance rates of giving patients a copy of their referral letter: randomised controlled trial.

ABSTRACT: OBJECTIVES:To investigate whether sending patients a copy of their referral letter can reduce non-attendance at outpatient departments. DESIGN:Blinded randomised controlled trial. SETTING:13 general practices in Exeter, Devon. SUBJECTS:2078 new consultant referrals from 26 doctors. MAIN OUTCOME MEASURES:Non-attendance at outpatient departments. RESULTS:The doctors excluded 117 (5.6%) referrals, and 100 (4.8%) received no appointment. Attendance data were available for 1857 of the 1861 patients sent an appointment (99.8%). The receipt of a copy letter had no effect on the non-attendance rate: copy 50/912 (5.5%) versus control 50/945 (5.3%). CONCLUSION:Copy letters are ineffective in reducing non-attendance at outpatient departments.

SUBMITTER: Hamilton W

PROVIDER: S-EPMC27884 | biostudies-literature | 1999 May

REPOSITORIES: biostudies-literature

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Effect on hospital attendance rates of giving patients a copy of their referral letter: randomised controlled trial.

Hamilton W W Round A A Sharp D D

BMJ (Clinical research ed.) 19990501 7195

<h4>Objectives</h4>To investigate whether sending patients a copy of their referral letter can reduce non-attendance at outpatient departments.<h4>Design</h4>Blinded randomised controlled trial.<h4>Setting</h4>13 general practices in Exeter, Devon.<h4>Subjects</h4>2078 new consultant referrals from 26 doctors.<h4>Main outcome measures</h4>Non-attendance at outpatient departments.<h4>Results</h4>The doctors excluded 117 (5.6%) referrals, and 100 (4.8%) received no appointment. Attendance data wer ...[more]

PMID: 10334750

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Project description:BackgroundAccidental falls by older patients in hospital are one of the most commonly reported adverse events. Falls after discharge are also common. These falls have enormous physical, psychological and social consequences for older patients, including serious physical injury and reduced quality of life, and are also a source of substantial cost to health systems worldwide. There have been a limited number of randomised controlled trials, mainly using multifactorial interventions, aiming to prevent older people falling whilst inpatients. Trials to date have produced conflicting results and recent meta-analyses highlight that there is still insufficient evidence to clearly identify which interventions may reduce the rate of falls, and falls related injuries, in this population.Methods and designA prospective randomised controlled trial (n = 1206) is being conducted at two hospitals in Australia. Patients are eligible to be included in the trial if they are over 60 years of age and they, or their family or guardian, give written consent. Participants are randomised into three groups. The control group continues to receive usual care. Both intervention groups receive a specifically designed patient education intervention on minimising falls in addition to usual care. The education is delivered by Digital Video Disc (DVD) and written workbook and aims to promote falls prevention activities by participants. One of the intervention groups also receives follow up education training visits by a health professional. Blinded assessors conduct baseline and discharge assessments and follow up participants for 6 months after discharge. The primary outcome measure is falls by participants in hospital. Secondary outcome measures include falls at home after discharge, knowledge of falls prevention strategies and motivation to engage in falls prevention activities after discharge. All analyses will be based on intention to treat principle.DiscussionThis trial will examine the effect of a single intervention (specifically designed patient education) on rates of falls in older patients in hospital and after discharge. The results will provide robust recommendations for clinicians and researchers about the role of patient education in this population. The study has the potential to identify a new intervention that may reduce rates of falls in older hospital patients and could be readily duplicated and applied in a wide range of clinical settings.

Project description:IntroductionTo improve maternal and fetal outcomes among patients with obstructed labour (OL) in low-resource settings, the associated electrolyte and metabolic derangements must be adequately corrected. Oral fluid intake during labour and preoperative intravenous fluid replacement following OL corrects the associated dehydration and electrolyte changes, but it does not completely reverse the metabolic acidosis, that is, a cause of intrapartum birth asphyxia and a risk factor for primary postpartum haemorrhage due to uterine atony. Sodium bicarbonate is a safe, effective, cheap and readily available acid buffer, that is widely used by sportspeople to improve performance. It also appears to improve fetal and maternal outcomes in abnormally progressing labour. However, its effects on maternal and fetal outcomes among patients with OL is unknown. We aim at establishing the effect of a single-dose preoperative infusion of sodium bicarbonate on maternal and fetal lactate levels and clinical outcomes among patients with OL.Methods and analysisThis will be a double blind, randomised controlled clinical phase IIb trial. We will randomise 478 patients with OL to receive either 50 mL of placebo with standard preoperative infusion of normal saline (1.5 L) or 4.2 g of sodium bicarbonate solution (50 mL of 50 mmol/L) with the preoperative infusion of normal saline (1.5 L). The primary outcome will be mean lactate levels in maternal capillary blood at 1 hour after study drug administration and in the arterial cord blood at birth. We will use the intention-to-treat analysis approach. Secondary outcomes will include safety, maternal and fetal morbidity and mortality up to 14 days postpartum.Ethics and disseminationMakerere University School of Medicine Research and Ethics Committee and Uganda National Council for Science and Technology have approved the protocol. Each participant will give informed consent at enrollment.Trial registration numberPACTR201805003364421.

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Effect on hospital attendance rates of giving patients a copy of their referral letter: randomised controlled trial.

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Effect on hospital attendance rates of giving patients a copy of their referral letter: randomised controlled trial.

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